Spinal precautions, also known as spinal immobilization and spinal motion restriction, are efforts to prevent movement of the spine in those with a risk of a
spine injury.[1] This is done as an effort to prevent injury to the
spinal cord.[1] It is estimated that 2% of people with
blunt trauma will have a spine injury.[2]
Uses
Spinal immobilization was historically used routinely for people who had experienced physical trauma.[3] There is; however, little evidence for its routine use.[3]Long spine boards are often used in the prehospital environment as part of spinal immobilization.[4] Due to concerns of side effects the National Association of EMS Physicians and the
American College of Surgeons recommend its use only in those at high risk.[4] This includes: those with blunt trauma who have a
decreased level of consciousness, pain or tenderness in the spine, those with numbness or weakness believed to be due to a spinal injury, and those with a significant trauma mechanism that are intoxicated or have other major injuries.[4] In those with a definite spinal cord injury immobilization is also recommended.[2]
Neck
There is little high quality evidence for spinal motion stabilization of the neck before arrival at a hospital.[5][6][7] Using a
hard cervical collar and attaching a person to an EMS stretcher may be sufficient in those who were walking after the accident or during long transports.[4] In those with penetrating neck or head trauma spinal immobilization may increase the risk of death.[5][8] If
intubation is required the cervical collar should be removed and inline stabilization provided.[2]
Mid and low back
Spinal motion stabilization is not supported for penetrating trauma to back including that caused by gun shot wounds.[8]
Paramedics are able to accurately determine who needs or does not need neck immobilization based on an algorithm.[2] There are two main algorithms, the
Canadian C-spine rule and NEXUS. The Canadian C-spine rule appears to be better.[9] However, following either rule is reasonable.[10]
Side effects
Concern with use include: pain, agitation, and
pressure ulcers.[4] A systematic review found
cervical collar related skin ulcers from the devices in 7 to 38%.[11]
If a longboard is used, cushioning it is useful to decrease discomfort due to pressure.[2] A
vacuum mattress and
scoop board typically results in lower pressures.[2]
Mechanism of action
Studies with volunteers have found that using a hard collar, head stabilization with rolled up towels, and a long board decrease movement of the board.[2] What impact this has is unclear.[2]
^
abOteir, AO; Smith, K; Jennings, PA; Stoelwinder, JU (August 2014). "The prehospital management of suspected spinal cord injury: an update". Prehospital and Disaster Medicine. 29 (4): 399–402.
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PMID25046238.
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^
abcdeWhite CC, 4th; Domeier, RM; Millin, MG; Standards and Clinical Practice Committee, National Association of EMS, Physicians (Apr–Jun 2014). "EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma". Prehospital Emergency Care. 18 (2): 306–14.
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PMID24559236.
S2CID207521864.{{
cite journal}}: CS1 maint: multiple names: authors list (
link) CS1 maint: numeric names: authors list (
link)
^
abOteir, AO; Smith, K; Stoelwinder, JU; Middleton, J; Jennings, PA (12 January 2015). "Should suspected cervical spinal cord injury be immobilised?: A systematic review". Injury. 46 (4): 528–35.
doi:
10.1016/j.injury.2014.12.032.
PMID25624270.
^
abStuke, LE; Pons, PT; Guy, JS; Chapleau, WP; Butler, FK; McSwain, NE (September 2011). "Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee". The Journal of Trauma. 71 (3): 763–9, discussion 769-70.
doi:
10.1097/ta.0b013e3182255cb9.
PMID21909006.